The proposed research seeks to investigate how a more rational and Cost- effective balance between medical intervention and self-care can be achieved for chronic pain. These goals will be accomplished through three interrelated studies: Study 1 assesses long-term patterns of disability, medicine use, health care use, and health care costs among primary care back pain and headache patients. Study 2 assesses approaches to integrating cognitive-behavioral interventions into health care for chronic pain. Study 1 - Primary care back pain (N=975) and headache (N=625) patients will be interviewed four years after enrollment in a completed 3 wave study. The aims of this follow-up are to: a) provide data on the long- term outcomes of dysfunctional chronic pain; b) determine how patterns of pain medication use, health care use and health care costs change over four years in relation to pain dysfunction status; and c) identify baseline characteristics of pain patients for whom long-term health care costs may outweigh costs of cognitive-behavioral interventions. Study 2 - In this study, visits with 89 back pain and 50 headache patients will be audiotaped and coded for physician-patient interaction. Study subjects will be interviewed one month after their visit to assess short-term outcomes. The objectives of Study 2 are: (i) to determine the extent to which physicians vs. patients initiate "medical model" inter- ventions for dysfunctional and nondysfunctional patients; and 2 to identify patient and provider behaviors that would impede or enhance integration of cognitive-behavioral interventions into the medical encounter.